'I put the knife in and pulled it up. Once wasn't enough. I did it again. Then I cut open my womb'

By Ronald Buchanan and Keith Dannemiller

12:01AM BST 25 Apr 2004

A woman in a remote village carried out the first successful DIY caesarean section. "This is the one," says Ines Ramirez. From the corner of her one-roomed house, she picks up a wooden-handled knife with a six-inch blade. "I use it to cut fruit and vegetables now."

It is also the knife which Ines plunged into her womb and drew up her abdomen to carry out the world's only known successful, self-performed caesarean section. Today, she lies on the rough floor and demonstrates exactly how she gripped the knife on that night in remote, rural Mexico when she went into premature labour, five hours' travel from the nearest doctor.

Terrified lest the baby be still-born, as her previous one had been, Ines was determined to bring him into the world as quickly as possible. Fortified by two cups of almost 100 per cent proof alcohol, she grasped the knife by the blade rather than the handle, and used her index finger and thumb to apply pressure, as one would with a craft knife.

"I put the knife in here, then pulled it up," Ines says, pointing to her lower abdomen. "Once wasn't enough. I did it again. I was crying and screaming, in terrible pain." Lifting her skirt, she reveals a scar about seven inches long. "Then I cut open my womb and pulled the baby out by his feet. He cried straight away," For the first time in her company, Ines smiles.

A mother-of-eight, she lives in a hamlet in the Oaxaca region of Mexico. News of her remarkable do-it-yourself caesarean spread around the world only after the doctor who would eventually tend for the mother and her baby son, Orlando, was sent on attachment to a hospital in Chicago. An American colleague later wrote it up in the International Journal for Gynaecology and Obstetrics.

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Ines emerges from her house, one of three small dwellings built of roughly made bricks that stand in a clearing of tierra colorada, the red earth common in the region, surrounded by a pine forest. A slim but sturdy woman about five feet tall, she is wearing a bright red dress and a green apron. Three young children are in attendance. Ines, 43, had her first child when she was 15.

Her house has bare walls and no furniture, though there is a black-and-white television in one corner. Electricity has recently arrived in her village of Rio Talea, but water has to be brought from a well. A fat pig forages among piles of chopped wood around the outdoor stove. Inside, Ramirez pounds maize on a slab of volcanic rock to make the tortillas that form the basis of the family's diet, enlivened by salsas of tomato, chilli and onion. In this remote district, meat is a rarity.

Today, as on the night Ines gave birth, there is no sign of a man around the house. "En el campo [in the countryside]," she shrugs. Gently pressed to elaborate, she replies again: "En el campo," suggesting that the children's father is an itinerant labourer, or perhaps a wood cutter who illegally fells trees at night.

Haltingly at first, Ines tells the remarkable story of how she gave birth. "I had seven children before Orlando," she says. "There was no problem with the births. But the eighth baby died. My waters broke and the midwife said I needed a caesarean but I couldn't get to the hospital in time. I felt the baby struggling but then it stopped moving.

"When I was seven months pregnant with Orlando, one night the pain began. It was terrible. I couldn't bear it. I started to panic. I knew I had to do something or this baby would die too. I knew I had to get it out somehow."

Her son Benito, who was then eight years old, was sent up the hill to a little shop half a mile away to buy a kitchen knife. "We had a knife but it wasn't that sharp." In her desperation not to lose another child, Ines cut into her womb as if cutting a tortilla. "Blood came out of me like a fountain." Pushing aside her internal organs, she rummaged around inside and pulled out her son. To her great joy, the baby cried, and appeared healthy, but Ines's ordeal was only just beginning. As mother and baby lay on the floor, Ines cut the umbilical cord before putting her organs back in place as best as she could. "It was all a mess," she remembers.

Her son, Benito, was sent off once again - this time to find a man with first-aid training. He arrived with a sewing needle and thread and attempted to stitch the wound. "Then he piled me into a pasajero [a rural mini-bus] and drove me to the clinic." The clinic was an hour's drive away along bumpy winding roads, in the village of San Lorenzo Texmelucan. "A lady doctor saw me," Ines continued. "She took one look and said, 'You've got to go to San Pedro'. They put me and the baby in the back of a pick-up truck."

The state hospital at San Pedro was another two-hour drive away down unpaved roads, on the main highway that links Oaxaca City to Puerto Escondido, a holiday resort on the Mexican coast. By this stage, her pain numbed only by the alcohol, Ines was near to collapse. "The lady doctor had phoned San Pedro and they'd sent an ambulance," she says. "I can hardly remember the rest."

Four years later - Orlando is now a healthy little boy who attends nursery school every day - Dr Onorio Galvan, head of the obstetrics department in the state hospital in San Pedro, remains astonished. "She was my star patient," he says. Switching on his computer, he plays a little clip of a small woman in a white hospital smock, carrying a baby in her arms. It is his reminder of the week - remarkably, she stayed no longer - that Ines spent in his hospital.

"I couldn't believe it," says Dr Galvan. "There was no sepsis in the wound, no internal bleeding. She was back on her feet in a couple of days." Five days later, she was on her way back home - by bus. Today, her younger children are charging around the house. Orlando, a bright-eyed boy, breaks into a run to catch up with his brother and sister, aged 12 and 13 respectively. He falls over, gets up, dusts himself down and carries on.

As for his mother, she still remembers how she brought Orlando home from hospital on that long bus journey. The bus followed a circuitous route through the hills to Ines's village. It was a 12-hour journey, so Ines didn't stay on board to its final destination. Reaching the mountains where she lives, she got off. With Orlando strapped to her back in a shawl, she walked for one and a half hours along footpaths to reach her home. "It was a short-cut," she explains.